Tuesday, June 14, 2016

Here's a video of the plenary talks/announcements at the White House Organ Summit yesterday. I give the last brief talk, from minute 43-48. (5 minute talks are hard:). I report on the plan to start some nondirected donor kidney exchange chains with deceased donor kidneys at Walter Reed, which has some flexibility in the allocation of deceased donor kidneys.

Here's the text of my five-minute speech (which I wrote out in advance, to stay on script and keep on time):

"White House
Organ Summit: Deceased Donor Chains

I’m Al Roth,
an economist at Stanford.

Most people
waiting for transplants are waiting for kidneys. And kidneys are special,
because healthy people have two and can remain healthy with one. So kidneys can
be donated by living as well as deceased donors. Each year in the U.S. we transplant over
5,000 living donor kidneys, along with over 11,000 deceased donor kidneys.

Kidney transplantation is also special: it is both
the best treatment for kidney failure, giving recipients many more years of
life—and it is also the cheapest treatment. The American health care system
saves over $250,000 in five years after a transplant, because dialysis is much
more expensive than transplantation and post-transplant care.

I’m going to tell you now about how
some living donor kidney transplants are organized, as background for one of
the quite concrete announcements we have today.

Sometimes a
person is healthy enough to donate a kidney but can’t give to the patient he
loves, because kidneys have to be biologically compatible. This opens up the
possibility of kidney exchange (and exchange is where economists come in).
Kidney exchange is a kind of matching market in which
patient-donor pairs can donate compatible kidneys to one another so that each
patient gets a compatible kidney. For example, if you and I are healthy enough
to donate a kidney, but can’t donate to the patient we love, maybe my kidney is
compatible with your patient and yours with mine, and so a simple exchange
between two patient-donor pairs can make two additional transplants possible.
In the last 10-15 years, kidney exchange has become a standard part of American
medicine, resulting in thousands of additional transplants.

Sometimes a non-directed donor comes
forward—an altruistic donor who wishes to donate a kidney, and doesn’t have a
particular patient in mind. These donors can spark chains of transplants that
help patient-donor pairs in the kidney exchange pool, and patients on the deceased
donor waiting list who don’t have a living donor. Some of these chains can
produce many transplants, ever since we have learned to organize them as Non-simultaneous
chains, in which the non-directed donor initiates a chain by giving to a
patient-donor pair whose donor then gives to another pair, etc., most often
ending with a donation to someone on the waiting list who doesn’t have a living
donor. These chains can be long because
they don’t have to be conducted simultaneously since every pair receives a
kidney before giving one, so that they don’t risk giving a kidney and not
getting one. Mike Rees who is here today
organized the first non-simultaneous chain, which had twenty people--ten donors
and ten transplant recipients--in the picture that was eventually published in
People Magazine.

The average
non-directed chain produces five transplants. That is, if someone offers to
donate a kidney to start a chain - someone offering to help a stranger with
this amazing gift of a kidney and a life free from dialysis - then on average,
that one donor's gift will start a chain which produces 5 transplants

With that in
mind, earlier this year, several eminent surgeons and I published an article in
the American Journal of Transplantation noting that deceased donor kidneys are
almost all non-directed. So we proposed that we should occasionally start non-directed
donor chains with deceased donor kidneys – which are non-directed donor kidneys
that today are used to produce just a single transplant. Carefully done, this
could substantially increase the number of transplants for all patients –both
those waiting without a living donor and those waiting for a kidney exchange.

Today,
surgeons at Walter Reed who are here today have announced that they are going
to pilot this idea through the military share program, which gives
them the flexibility to allocate certain deceased donor kidneys to the benefit
of veterans and service members. This new initiative at Walter Reed may soon
show us how to move forward on a larger scale in using some deceased donor
organs to start chains of multiple transplants.

To
summarize, kidney chains can play an important role in increasing transplants.
Since the first long non-simultaneous non-directed donor chain was organized by
Dr Rees in 2007, thousands of kidney exchange transplants have been
accomplished, more than half through non-directed donor chains. These save both
lives and money by increasing the number of transplants. So we should take good
care of our non-directed living donors—and there is growing consensus that we
should at least figure out ways to reimburse all donors for their financial costs,
including lost wages. And we should, in gratitude to our deceased donors, make
the best use possible of their non-directed donation.

I’d like to
personally thank Walter Reed for their initiative in pioneering the use of
deceased donor kidneys to start kidney exchange chains that will increase
donations and benefit both those waiting for deceased donors and those waiting
for exchange with other patient donor pairs. Starting kidney transplant chains
with deceased donor kidneys has the potential to be a very significant
innovation."

Monday, April 11, 2016

"BETHESDA, Md., June 13, 2016 — Walter Reed National Military Medical Center officials today announced a pilot program to pioneer kidney paired donation chains started via the military share program, in which families of active duty military service members donate one of their kidneys to patients listed for transplant at the medical center’s campus here.

...

""We are excited to participate in this initiative, which has the potential to increase organ allocation for our patients,” Navy Capt. (Dr.) Eric Elster, professor and chairman of surgery at the Uniformed Services University of Health Sciences and Walter Reed National Military Medical Center said. “While it will require overcoming logistical barriers, we in military medicine excel at such challenges."

Walter Reed surgeons perform an average of 25 transplants per year on patients from across the country, and the medical center also maintains a living donor kidney transplant program that participates in national paired kidney exchanges.

Army Maj. (Dr.) Jason Hawksworth, transplant chief at Walter Reed, said his team “looks forward to contributing to the innovative initiative that may exponentially increase the availability of life-saving transplants on patients throughout the nation."

According to the Scientific Registry of Transplant Recipients, a regulatory body that tracks transplants, Walter Reed has the best organ transplant outcomes in the greater Washington-Baltimore region."